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. 2025 Jun 3;26(1):276.
doi: 10.1186/s12882-025-04188-y.

Addressing the inequity of access to home Dialysis in Europe: recommendations for action informed by an international consensus exercise

Simon J Davies  1 , Bert Bammens  2   3 , Ilaria de Barbieri  4 , Edwina A Brown  5 , Jan van Cruchten  6 , Dani Gallego  6 , Eric Goffin  7 , Maurizio Gallieni  8 , Sotiroula Gliki  9 , Jeroen P Kooman  10 , Gert Meeus  11 , May-Britt Moeslund-Hansen  12 , Peter Rutherford  13 , Raymond Vanholder  14   15 , Martin Wilkie  16 , Wim Van Biesen  17
Affiliations

Addressing the inequity of access to home Dialysis in Europe: recommendations for action informed by an international consensus exercise

Simon J Davies et al. BMC Nephrol. .

Abstract
in English, Spanish

Background: Use of Home Dialysis (referring to both peritoneal and home haemodialysis throughout this study), is under-exploited and highly variable across Europe, and this is the case both within as well as between countries. Several, predominantly modifiable barriers have been described that explain this inequity of access, but as yet no recommendations have been agreed upon as to how to address the problem.

Methods: A multi-disciplinary multi-organisational policy forum representing the key stakeholders was held at the EuroPD meeting in Bruges, November 2023 with the purpose of defining solutions and actions that the wider nephrology community should take to reduce disparities in access to home-based therapies. Three key themes were identified by a steering group prior to the forum: Dialysis Provider Motivation, Patient Empowerment and Training and Workforce Issues. Breakout discussion groups for each theme were asked to prioritise up to three actions per theme. These were further refined by the steering group and developed into proposed actions to be taken forward by the kidney failure community.

Results: 112 registrants attended the forum representing patients (5%), doctors, (57%) nurses, (13%) industry (7%) and various other roles (18%). The following actions were proposed: (1) a granular European audit of financial disincentives affecting decisions of policy makers, providers, patients and industry; (2) engaging national professional societies to challenge complacency towards uptake of home-based therapies; (3) stimulate networking to support small, inexperienced centres; (4) extending access to assisted peritoneal dialysis; (5) greater involvement of patients (locally and nationally) at every step, especially for advocacy; (6) empowering patients with transparent information; (7) mandating inclusion of training and exposure to Home Dialysis in national curricula; (8) promotion of career sub-specialists (doctors and nurses) with specific qualification in Home Dialysis; (9) promoting access to high quality training resources.

Conclusions: The kidney failure community can undertake a number of constructive actions to improve equity of access to Home Dialysis. The Policy Forum steering group who are representative of the key stakeholders have committed to taking this programme forward.

What is known There is substantial variability and under-use of Home Dialysis across Europe pointing to inequity of access. Multiple modifiable causes have been identified.This study adds We report on a multi-disciplinary policy forum that has identified a number of actions to address this inequity. These include a Europe-wide granular audit of financial disincentives, transparency of data, recommendations for networking, availability of assisted peritoneal dialysis, speciality curriculum templates for professionals and training opportunities.Potential Impact These actions are expected to empower patients wishing to access Home Dialysis and physicians wanting to build a Home Dialysis service.

Keywords: Home dialysis; Home haemodialysis; Modality choice; Patient empowerment; Peritoneal dialysis; Training; Workforce.

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Conflict of interest statement

Declarations. Ethics approvals and consent to participate: The study was approved by the Ethical Committee of the University Hospital Ghent (THE-2022-0179) and adhered to the Declaration of Helsinki. Participants were informed of the purpose of the Policy Forum in the form of an open invitation and were requested to sign up to prior to attending the in the meeting which was taken as consent to participate. Consent for publication: Participants were verbally informed of the intention to publish the findings of the forum before the meeting commenced. Competing interests: SD: has received honoraria from Baxter HealthCare and Fresenius Medical Care and is on the steering group for the Behring CSL300_2301 POSIBIL₆ESKD trial.MG: Becton Dickinson: Consultant for clinical studies on vascular access (May-2022 – May-2024) Vifor: Steering Committee, clinical study on difelikefalin; Sponsorship for meeting participation and fees for presentations in symposia: Amicus, AstraZeneca, Baxter, Medtronic, Sanofi, Vifor. RV is advisor to AstraZeneca, Glaxo Smith Kline, Fresenius Kabi, Novartis, Baxter, Nipro, Fresenius Medical Care and Nextkidney.EAB is on advisory boards of Fresenius Medical Care, AWAK Technolog and iRenMedical; she receives speaker fees from Baxter Healthcare and Fresenius Medical CareBB has received speaker’s fees from Baxter Healtcare. The dept. of Nephrology, Dialysis and Renal Transplantation of the University Hospitals Leuven has received research support from Baxter Healthcare, Nipro and Roche.EG is on advisory boards of Fresenius Medical Care, and has received research grants from Baxter Helathcare, speaker’s fees from Fresenius Medical Care, Baxter Heathcare, Physidia, Astra Zeneca, Bayer, and travel grants from Astra ZenecaMW provides consultant to Triomed AB and has received speakers honoraria from Baxter and a travel grant from Medici.PR is an employee of Baxter Healthcare and has stocks in Baxter Healthcare.WVB has received research grants from Baxter Healthcare, Fresenius Medical Care and Nipro.The other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
The multiple barriers that affect equity of access to Home Dialysis in Europe can be illustrated using the Swiss Cheese analogy. Each cheese slice is a barrier, arranged hierarchically according to their permissiveness. For example, some European countries do not have a legal framework in place to allow hemodialysis to be undertaken unsupervised at home. Access to Home Dialysis is maximised when the cheese barriers are overcome (as shown by the blue arrow)
Fig. 2
Fig. 2
Diagram summarising the process of developing the policy forum and formulating the recommendations and action plan
See this image and copyright information in PMC

References

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